This document discusses rehabilitation principles for multiple sclerosis (MS). It begins by defining MS as a chronic, progressive disease of the central nervous system characterized by demyelination of the brain and spinal cord. It then covers the epidemiology, pathogenesis, subtypes, common symptoms and signs, diagnosis using the McDonald criteria, disease severity as measured by EDSS, disease-modifying therapies, and approaches to managing common issues like gait impairment and fatigue through rehabilitation and exercise.
Physiotherapy management of Multiple sclerosisKeerthi Priya
This document provides an overview of the physical therapy management of multiple sclerosis. It discusses assessing patients through examinations of vital signs, cognition, sensation, motor function, posture, balance, gait, locomotion, aerobic capacity, and functional independence. Short term goals include minimizing progression, preventing complications, and maintaining respiratory and functional abilities while long term goals focus on decreasing spasticity and improving strength, range of motion, balance, and activities of daily living. Management techniques for weaknesses, spasticity, ataxia, fatigue, locomotion, and swallowing are outlined, including exercises, stretches, electrical stimulation, and energy conservation methods.
This document discusses Guillain-Barré syndrome (GBS), including its definition, clinical features, assessment scales, and phases. It defines GBS as an acute/subacute symmetrical motor neuropathy involving more than one peripheral nerve. The phases of GBS are described as the acute, plateau, and recovery phases. For each phase, goals of physical therapy and examples of interventions are provided, such as chest physiotherapy, positioning, stretching, and strengthening exercises to address weaknesses and functional limitations during the different stages of GBS.
Physiotherapy management of Head InjuryKeerthi Priya
This document discusses head injuries and their classification, as well as scales used to measure head injuries. It describes physical therapy management for mild, moderate, and severe head injuries. For severe injuries, PT focuses on preventing secondary complications like contractures and bed sores through positioning, splinting, and early mobility. For moderate injuries, interventions include motor relearning programs and task-oriented approaches. PT for mild injuries includes vestibular rehabilitation and balance training.
- Multiple sclerosis (MS) is a neurological disease involving damage to the protective myelin sheath surrounding the nerves in the central nervous system. It presents with a variety of symptoms such as vision problems, tingling/numbness, muscle weakness, balance issues, and fatigue.
- There are several types of MS defined by patterns of relapse and progression of symptoms. Management involves medications to reduce inflammation and manage relapses as well as physiotherapy focusing on exercises, balance training, managing fatigue, and compensatory strategies to improve function and quality of life.
Hierachical theory- says that higher centers control on lower center; but when higher center damage then this inhibitory control from the higher center is loss which leads to exageration of the movt.
In normal individual, these occur a smooth, rhythmic movt. Because there is a presence of control from higher center on lower center.
This document discusses spasticity management. It defines spasticity as a hypertonic motor disorder caused by injury to the corticospinal pathways. Signs of upper motor neuron syndrome include hyperactive stretch reflexes and involuntary flexor/extensor spasms. Spasticity is assessed using measures like the modified Ashworth scale and is treated using a multidisciplinary approach including oral medications, injections, surgery, and physiotherapy. Treatment aims to reduce spasticity and improve function and range of motion.
Spasticity, rigidity, hypotonia, dystonia, decerebrate rigidity, and decorticate rigidity are abnormal tones that can occur. Examination of tone includes initial observation, passive and active motion testing using scales like the Modified Ashworth Scale. Typical patterns of spasticity in upper and lower limbs are described for upper motor neuron lesions.
Spinal cord injuries can be either traumatic, from events like car accidents or falls, or non-traumatic, from conditions that damage the spinal cord. They are classified as either tetraplegia or paraplegia depending on whether the arms or legs are affected. Physiotherapy focuses on managing symptoms, preventing complications, and improving function through exercises for mobility, transfers, wheelchair skills, and more. The goal is to maximize independence and allow patients to safely perform daily living activities. Prognosis depends on the completeness of the injury and potential for recovery decreases over time as improvement plateaus.
Physiotherapy management of Multiple sclerosisKeerthi Priya
This document provides an overview of the physical therapy management of multiple sclerosis. It discusses assessing patients through examinations of vital signs, cognition, sensation, motor function, posture, balance, gait, locomotion, aerobic capacity, and functional independence. Short term goals include minimizing progression, preventing complications, and maintaining respiratory and functional abilities while long term goals focus on decreasing spasticity and improving strength, range of motion, balance, and activities of daily living. Management techniques for weaknesses, spasticity, ataxia, fatigue, locomotion, and swallowing are outlined, including exercises, stretches, electrical stimulation, and energy conservation methods.
This document discusses Guillain-Barré syndrome (GBS), including its definition, clinical features, assessment scales, and phases. It defines GBS as an acute/subacute symmetrical motor neuropathy involving more than one peripheral nerve. The phases of GBS are described as the acute, plateau, and recovery phases. For each phase, goals of physical therapy and examples of interventions are provided, such as chest physiotherapy, positioning, stretching, and strengthening exercises to address weaknesses and functional limitations during the different stages of GBS.
Physiotherapy management of Head InjuryKeerthi Priya
This document discusses head injuries and their classification, as well as scales used to measure head injuries. It describes physical therapy management for mild, moderate, and severe head injuries. For severe injuries, PT focuses on preventing secondary complications like contractures and bed sores through positioning, splinting, and early mobility. For moderate injuries, interventions include motor relearning programs and task-oriented approaches. PT for mild injuries includes vestibular rehabilitation and balance training.
- Multiple sclerosis (MS) is a neurological disease involving damage to the protective myelin sheath surrounding the nerves in the central nervous system. It presents with a variety of symptoms such as vision problems, tingling/numbness, muscle weakness, balance issues, and fatigue.
- There are several types of MS defined by patterns of relapse and progression of symptoms. Management involves medications to reduce inflammation and manage relapses as well as physiotherapy focusing on exercises, balance training, managing fatigue, and compensatory strategies to improve function and quality of life.
Hierachical theory- says that higher centers control on lower center; but when higher center damage then this inhibitory control from the higher center is loss which leads to exageration of the movt.
In normal individual, these occur a smooth, rhythmic movt. Because there is a presence of control from higher center on lower center.
This document discusses spasticity management. It defines spasticity as a hypertonic motor disorder caused by injury to the corticospinal pathways. Signs of upper motor neuron syndrome include hyperactive stretch reflexes and involuntary flexor/extensor spasms. Spasticity is assessed using measures like the modified Ashworth scale and is treated using a multidisciplinary approach including oral medications, injections, surgery, and physiotherapy. Treatment aims to reduce spasticity and improve function and range of motion.
Spasticity, rigidity, hypotonia, dystonia, decerebrate rigidity, and decorticate rigidity are abnormal tones that can occur. Examination of tone includes initial observation, passive and active motion testing using scales like the Modified Ashworth Scale. Typical patterns of spasticity in upper and lower limbs are described for upper motor neuron lesions.
Spinal cord injuries can be either traumatic, from events like car accidents or falls, or non-traumatic, from conditions that damage the spinal cord. They are classified as either tetraplegia or paraplegia depending on whether the arms or legs are affected. Physiotherapy focuses on managing symptoms, preventing complications, and improving function through exercises for mobility, transfers, wheelchair skills, and more. The goal is to maximize independence and allow patients to safely perform daily living activities. Prognosis depends on the completeness of the injury and potential for recovery decreases over time as improvement plateaus.
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
Rood's approach is a neurophysiological technique developed in 1940 based on reflex models of motor control. It uses sensory stimulation to normalize tone and elicit desired muscle responses based on developmental sequences. The key concepts are:
1. Categorizing muscles as tonic or phasic for stability or mobility.
2. Using ontogenic sequences of motor and vital functions development.
3. Applying appropriate sensory stimuli like touch or vibration to proprioceptive, exteroceptive, and vestibular receptors.
4. Manipulating the autonomic nervous system with techniques like icing or warming.
Neurosyphilis and its physiotherapy managementMuskan Rastogi
This document discusses neurosyphilis, a sexually transmitted disease caused by Treponema pallidum that affects the nervous system. It describes four clinical types of neurosyphilis: asymptomatic neurosyphilis, meningovascular neurosyphilis, Tabes dorsalis, and general paralysis of insane. For each type, it outlines the characteristic symptoms, areas of the nervous system affected, and typical progression. The document also covers investigations, medical management focusing on penicillin treatment, and principles of physiotherapy management including assessment, goals, and specific plans and exercises.
The document discusses stroke, including its definition, causes, risk factors, symptoms, assessment, recovery stages, and complications. Key points include:
- Stroke is defined as sudden neurological dysfunction due to abnormal cerebral circulation lasting over 24 hours.
- Common causes include atherosclerosis, cerebral thrombus, embolism from the heart.
- Risk factors include hypertension, diabetes, heart disease, smoking, obesity.
- Symptoms can include weakness, numbness, vision issues, speech problems.
- Recovery is assessed based on severity, duration, and affected brain region. Complications can include contractures, seizures, DVT.
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
1) Entrapment neuropathies occur when nerves are injured by chronic compression, angulations, or stretching forces, causing mechanical damage. Carpal tunnel syndrome is an example where the median nerve is compressed as it passes through the wrist.
2) Clinical features of entrapment neuropathies include pain, numbness, tingling, burning, and weakness in the affected area. Electrodiagnostic tests like nerve conduction studies and electromyography are important diagnostically.
3) Treatment involves conservative measures like splinting, steroid injections, and physical therapy. Surgery is considered if conservative treatment fails or for severe cases. Proper identification of the site of nerve entrapment is key to determining appropriate treatment
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
PHYSIOTHERAPY MANAGEMENT OF POST STROKE PATIENT.Jonasbrother2013
This document provides an overview of physiotherapy management for stroke. It begins with definitions of stroke and transient ischemic attack. It then discusses risk factors, types, signs and symptoms, diagnosis, and medical management of stroke. The remainder of the document focuses on the physiotherapy assessment and treatment approaches in both the acute and post-acute stages. The assessment covers various body functions and structures, while the treatment approaches aim to improve motor function, mobility, balance, sensation, flexibility, strength, and reduce spasticity to achieve functional independence.
Guillain Barre Syndrome (GBS) is an acute immune-mediated polyneuropathy where there is demyelination of peripheral nerves. It presents with rapidly progressive symmetric motor weakness, areflexia, and sensory symptoms. Diagnosis is based on clinical features and albuminocytological dissociation seen on lumbar puncture. Treatment involves plasmapheresis, IVIG, or steroids to reduce immune-mediated damage. Physiotherapy management focuses on maintaining respiratory function, range of motion, muscle strength, and functional mobility through various exercises to aid recovery.
Pusher syndrome is a disorder following brain damage where patients actively push away from their non-paretic side, losing postural balance. It is caused by damage to the posterolateral thalamus, altering perception of the body's orientation to gravity. Treatment focuses on helping patients visually explore their surroundings to recognize their tilted posture. Prognosis is generally good, with function often recovering within 6 months.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
This presentation contains detailed knowledge about Down's Syndrome its types, clinical presentation, diagnosis, medical and physio therapeutic management of the condition.
Down syndrome is a condition in which a person has an extra chromosome. Chromosomes are small “packages” of genes in the body. They determine how a baby’s body forms and functions as it grows during pregnancy and after birth. Typically, a baby is born with 46 chromosomes. Babies with Down syndrome have an extra copy of one of these chromosomes, chromosome 21. A medical term for having an extra copy of a chromosome is ‘trisomy.’ Down syndrome is also referred to as Trisomy 21. This extra copy changes how the baby’s body and brain develop, which can cause both mental and physical challenges for the baby.
Osteoporosis is a disease characterized by low bone density and deterioration of bone tissue, leading to fragile bones and increased risk of fractures. It is most common in postmenopausal women and older adults. Key signs include loss of height, back pain from compressed fractures, and fractures of the spine, hips and wrists. Treatment focuses on lifestyle changes like exercise and diet to build bone density, as well as medications when needed to prevent further bone loss and reduce fracture risk. Physiotherapy emphasizes posture, balance training, strength exercises and avoiding flexion to help manage symptoms.
Spina Bifida: Physiotherapy in the management of meningomyeloceleAyobami Ayodele
Spina bifida is a treatable spinal cord malformation that occurs in varying degrees of severity. Meningomyelocele is associated with abnormal development of the cranial neural tube, which results in several characteristic CNS anomalies. About 90% of babies born with Spina Bifida now live to be adults, about 80% have normal intelligence and about 75% play sports and do other fun activities. Most do well in school, and many play in sports.
This presentation is detail about Volta therapy which is commonly used in paediatric neurological conditions and also for adults. this presentation explains what are the various techniques, methods of application of Volta therapy, indications, contraindications, etc.
Multiple Sclerosis (MS) is a chronic, usually progressive, disease that primarily affects young adults. More than 350,000 people in the United States and 2.5 million worldwide have been diagnosed with MS. Multiple Sclerosis Physical Therapy for Multiple Sclerosis is a disease that involves the loss of myelin, a material that covers and protects the nerves in the body's central nervous system.
Controlled use of sensory stimulus.
Specific Motor response
Normalization of muscle tone
Use of Developmental sequences.
Sensorimotor development = from lower to higher level.
Use of activity to demand a purposeful response.
Practice of sensory motor response is necessary for motor learning.
This document provides an overview of syringomyelia, including its pathogenesis, pathology, classification, clinical features, and natural history. Syringomyelia is a condition characterized by fluid-filled cavities within the spinal cord. It most commonly affects the cervical and thoracic regions. Clinical features include pain and sensory loss. The natural history varies, but symptoms typically progress slowly over years, with some patients experiencing stabilization or spontaneous resolution in rare cases.
Hemophilia is a rare genetic bleeding disorder caused by a deficiency in clotting factors VIII or IX. Those with severe hemophilia can experience repeated spontaneous internal bleeding episodes, leading to joint damage, muscle atrophy, and loss of mobility. Proper treatment with clotting factor concentrates can prevent or treat bleeding episodes. However, around 30% of severe hemophilia patients develop inhibitors against treatment. Effective management requires early prophylactic treatment, education, coordinated multidisciplinary care, and continued research.
Introduction, principles of sensory re-education hypersensitivity and hyposensitivity, stages of training after nerve repair, uses and benefits, sensory reeducation in stroke - its principle. Actve and passive Sensory reeducation in stroke, orofacial sensory retraining
Rood's approach is a neurophysiological technique developed in 1940 based on reflex models of motor control. It uses sensory stimulation to normalize tone and elicit desired muscle responses based on developmental sequences. The key concepts are:
1. Categorizing muscles as tonic or phasic for stability or mobility.
2. Using ontogenic sequences of motor and vital functions development.
3. Applying appropriate sensory stimuli like touch or vibration to proprioceptive, exteroceptive, and vestibular receptors.
4. Manipulating the autonomic nervous system with techniques like icing or warming.
Neurosyphilis and its physiotherapy managementMuskan Rastogi
This document discusses neurosyphilis, a sexually transmitted disease caused by Treponema pallidum that affects the nervous system. It describes four clinical types of neurosyphilis: asymptomatic neurosyphilis, meningovascular neurosyphilis, Tabes dorsalis, and general paralysis of insane. For each type, it outlines the characteristic symptoms, areas of the nervous system affected, and typical progression. The document also covers investigations, medical management focusing on penicillin treatment, and principles of physiotherapy management including assessment, goals, and specific plans and exercises.
The document discusses stroke, including its definition, causes, risk factors, symptoms, assessment, recovery stages, and complications. Key points include:
- Stroke is defined as sudden neurological dysfunction due to abnormal cerebral circulation lasting over 24 hours.
- Common causes include atherosclerosis, cerebral thrombus, embolism from the heart.
- Risk factors include hypertension, diabetes, heart disease, smoking, obesity.
- Symptoms can include weakness, numbness, vision issues, speech problems.
- Recovery is assessed based on severity, duration, and affected brain region. Complications can include contractures, seizures, DVT.
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
1) Entrapment neuropathies occur when nerves are injured by chronic compression, angulations, or stretching forces, causing mechanical damage. Carpal tunnel syndrome is an example where the median nerve is compressed as it passes through the wrist.
2) Clinical features of entrapment neuropathies include pain, numbness, tingling, burning, and weakness in the affected area. Electrodiagnostic tests like nerve conduction studies and electromyography are important diagnostically.
3) Treatment involves conservative measures like splinting, steroid injections, and physical therapy. Surgery is considered if conservative treatment fails or for severe cases. Proper identification of the site of nerve entrapment is key to determining appropriate treatment
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
PHYSIOTHERAPY MANAGEMENT OF POST STROKE PATIENT.Jonasbrother2013
This document provides an overview of physiotherapy management for stroke. It begins with definitions of stroke and transient ischemic attack. It then discusses risk factors, types, signs and symptoms, diagnosis, and medical management of stroke. The remainder of the document focuses on the physiotherapy assessment and treatment approaches in both the acute and post-acute stages. The assessment covers various body functions and structures, while the treatment approaches aim to improve motor function, mobility, balance, sensation, flexibility, strength, and reduce spasticity to achieve functional independence.
Guillain Barre Syndrome (GBS) is an acute immune-mediated polyneuropathy where there is demyelination of peripheral nerves. It presents with rapidly progressive symmetric motor weakness, areflexia, and sensory symptoms. Diagnosis is based on clinical features and albuminocytological dissociation seen on lumbar puncture. Treatment involves plasmapheresis, IVIG, or steroids to reduce immune-mediated damage. Physiotherapy management focuses on maintaining respiratory function, range of motion, muscle strength, and functional mobility through various exercises to aid recovery.
Pusher syndrome is a disorder following brain damage where patients actively push away from their non-paretic side, losing postural balance. It is caused by damage to the posterolateral thalamus, altering perception of the body's orientation to gravity. Treatment focuses on helping patients visually explore their surroundings to recognize their tilted posture. Prognosis is generally good, with function often recovering within 6 months.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
This presentation contains detailed knowledge about Down's Syndrome its types, clinical presentation, diagnosis, medical and physio therapeutic management of the condition.
Down syndrome is a condition in which a person has an extra chromosome. Chromosomes are small “packages” of genes in the body. They determine how a baby’s body forms and functions as it grows during pregnancy and after birth. Typically, a baby is born with 46 chromosomes. Babies with Down syndrome have an extra copy of one of these chromosomes, chromosome 21. A medical term for having an extra copy of a chromosome is ‘trisomy.’ Down syndrome is also referred to as Trisomy 21. This extra copy changes how the baby’s body and brain develop, which can cause both mental and physical challenges for the baby.
Osteoporosis is a disease characterized by low bone density and deterioration of bone tissue, leading to fragile bones and increased risk of fractures. It is most common in postmenopausal women and older adults. Key signs include loss of height, back pain from compressed fractures, and fractures of the spine, hips and wrists. Treatment focuses on lifestyle changes like exercise and diet to build bone density, as well as medications when needed to prevent further bone loss and reduce fracture risk. Physiotherapy emphasizes posture, balance training, strength exercises and avoiding flexion to help manage symptoms.
Spina Bifida: Physiotherapy in the management of meningomyeloceleAyobami Ayodele
Spina bifida is a treatable spinal cord malformation that occurs in varying degrees of severity. Meningomyelocele is associated with abnormal development of the cranial neural tube, which results in several characteristic CNS anomalies. About 90% of babies born with Spina Bifida now live to be adults, about 80% have normal intelligence and about 75% play sports and do other fun activities. Most do well in school, and many play in sports.
This presentation is detail about Volta therapy which is commonly used in paediatric neurological conditions and also for adults. this presentation explains what are the various techniques, methods of application of Volta therapy, indications, contraindications, etc.
Multiple Sclerosis (MS) is a chronic, usually progressive, disease that primarily affects young adults. More than 350,000 people in the United States and 2.5 million worldwide have been diagnosed with MS. Multiple Sclerosis Physical Therapy for Multiple Sclerosis is a disease that involves the loss of myelin, a material that covers and protects the nerves in the body's central nervous system.
Controlled use of sensory stimulus.
Specific Motor response
Normalization of muscle tone
Use of Developmental sequences.
Sensorimotor development = from lower to higher level.
Use of activity to demand a purposeful response.
Practice of sensory motor response is necessary for motor learning.
This document provides an overview of syringomyelia, including its pathogenesis, pathology, classification, clinical features, and natural history. Syringomyelia is a condition characterized by fluid-filled cavities within the spinal cord. It most commonly affects the cervical and thoracic regions. Clinical features include pain and sensory loss. The natural history varies, but symptoms typically progress slowly over years, with some patients experiencing stabilization or spontaneous resolution in rare cases.
Hemophilia is a rare genetic bleeding disorder caused by a deficiency in clotting factors VIII or IX. Those with severe hemophilia can experience repeated spontaneous internal bleeding episodes, leading to joint damage, muscle atrophy, and loss of mobility. Proper treatment with clotting factor concentrates can prevent or treat bleeding episodes. However, around 30% of severe hemophilia patients develop inhibitors against treatment. Effective management requires early prophylactic treatment, education, coordinated multidisciplinary care, and continued research.
This document provides an overview of key concepts for understanding clinical trials, including types of trials, levels of evidence, randomization methods, statistical tests, and critical appraisal tools. It discusses randomized controlled trials and observational studies. It also outlines statistical analyses such as t-tests, ANOVA, relative risk, and numbers needed to treat. Critical appraisal aspects covered include sample size, selection bias, blinding, intention-to-treat analysis, and appropriate use of statistical tests to avoid biases. A variety of critical appraisal tools are also listed.
This document discusses ethics in research involving human subjects. It outlines potential harms from research, such as physical, psychological, or financial harm. It also discusses guidelines for ethical research, including obtaining informed consent and ensuring confidentiality and anonymity. The document compares deontological and teleological ethical philosophies and discusses issues like voluntary participation, avoiding harm, and obtaining informed consent.
This document provides guidance on conducting a literature review. It discusses that a literature review describes, summarizes, evaluates, and clarifies relevant studies on the selected topic. It establishes the theoretical basis and framework. The main types of literature reviews are evaluative, exploratory, and instrumental. An effective literature review is typically 15 to 30 pages. It justifies the research, ensures the topic hasn't been addressed before, and shows how the work adds to the field's understanding. The process of reviewing literature involves activities like searching databases, classifying information using Bloom's taxonomy. The document lists several medical and research databases to search for studies, theses, dissertations, and conference publications.
This document discusses different types of experimental research designs. It describes pre-experimental, true experimental, and quasi-experimental designs for group studies, as well as single-subject experimental designs like withdrawal, multiple baseline, and alternating treatments designs. Key factors that determine the appropriate experimental design include whether there will be a control group, random assignment of subjects, pretesting, and how the data will be analyzed. Threats to internal validity like history, maturation and testing effects as well as threats to external validity are also outlined.
Sensory processing disorder affects how the brain processes sensory information from the environment. It can cause individuals to be over-responsive or under-responsive to sensory input like touch, sound, and movement. A sensory room is designed to help individuals with SPD by providing controlled sensory activities and equipment tailored to their needs, with the goal of improving their ability to regulate and respond to sensory stimulation.
This document discusses key concepts in sampling and statistical inference. It defines parameters and statistics, and explains sampling distributions including the sampling distribution of the mean, proportion, and difference between means. The central limit theorem is covered, stating that as sample size increases, the sampling distribution of the mean approaches a normal distribution. Common distributions used in statistical inference like the t, F, and chi-square distributions are also summarized.
This document discusses several systemic conditions including diabetes mellitus, hypertension, and obesity. It defines each condition and covers classification, pathogenesis, clinical features, aims of management, measurement methods, causes and associated conditions, and impact on quality of life. Diabetes is classified into type 1 and 2 and is characterized by chronic hyperglycemia. Hypertension is defined based on systolic and diastolic blood pressure levels and is primarily or secondarily caused. Obesity is characterized by excess body fat and is measured using BMI, waist-hip ratio, and other methods. Each condition can impact quality of life.
Neurological physiotherapy is the treatment of individuals who have neurological impairments.
for example Traumatic Brain Injury or Stroke; Multiple Sclerosis, Spinal Cord Injury and Parkinson's disease.
Paul describes love as the most important virtue. Without love, even possessing great gifts or faith are worthless. Love is patient, kind, and does not envy or boast. It bears all things and hopes all things. Paul is in awe of Christ's love for humanity in dying for sins, which drives Paul with ecstasy to share that love with others.
The document discusses central nervous system infections, listing the main causes as bacterial, viral, fungal, and protozoal. It then provides more detailed information on specific types of infections, including listings of examples for each category. It also includes sections on meningitis that describe the introduction, clinical features, types (pyogenic bacterial, tubercular, and viral), investigations, treatment, and physical therapy management goals for meningitis patients.
This document discusses defining and selecting a research problem. It provides several criteria for selecting a good problem, including novelty, importance, interest to the researcher, and feasibility. A research problem refers to a difficulty a researcher wants to solve in a theoretical or practical context. A problem statement should clearly outline the problem in 1-2 sentences using the 5Ws (who, what, when, where, why). It should also address how the problem will be studied and tested. Characteristics of a good problem include being empirically testable and examining relationships between variables. Defining the problem sets the direction and goals of the study.
This document discusses geriatric rehabilitation and provides information on:
- The components of geriatric rehabilitation including accommodation, prevention of disability/restoration of function, and medical treatment of impairments.
- Physiological changes that occur with normal aging like changes in body composition, posture, gait, neurological and skin functions, and cardiopulmonary and urological systems.
- Principles of geriatric rehabilitation including ascertaining the level of function, differentiating between delirium, dementia and depression, determining patient goals and motivation, and emphasizing function over diagnosis.
- Common impairments seen in geriatrics like fractures, arthritis, Parkinson's disease, and peripheral nerve impairments.
Encephalitis: PT assessment and management Surbala devi
Encephalitis is an inflammation of the brain that can be caused by viruses, bacteria, or other microorganisms. Common symptoms include fever, headache, confusion, seizures, and personality changes. It is diagnosed through neurological exams, CSF analysis, imaging tests, and detection of antibodies or genetic material of the infecting pathogen. Treatment involves managing symptoms, treating any underlying infection, and rehabilitation. The prognosis depends on the cause - viral causes often have better outcomes than bacterial causes. Physical therapy can aid recovery through respiratory exercises, positioning, strengthening, and facilitating return of neurological function.
Sexually transmitted diseases (STDs) are infections that can be passed from one person to another during sexual activity. Common STDs include chlamydia, gonorrhea, herpes, HIV, and syphilis. STDs are caused by bacteria, parasites, viruses or yeast. Common symptoms include abnormal discharge, painful urination, sores, and rashes. STDs can be diagnosed through blood tests, urine tests, and examination of genital secretions. Treatment depends on the specific infection but may include antibiotics, antivirals, or other medications.
This document discusses sensory processing in children and whether sensory integration techniques support language development. It defines sensory integration and outlines various sensory processing patterns seen in children, including those with autism spectrum disorder. While early research showed improvements in language and other skills from sensory integration therapy, later meta-analyses found no effects on language outcomes. However, incorporating sensory-based activities into therapy sessions can help children organize their sensory systems and facilitate increased attention, which may support language production and comprehension. Examples of sensory-based activities are provided for different sensory processing profiles.
The document discusses several skin conditions and the role of physiotherapy in treating them. It describes conditions like acne, alopecia, psoriasis, vitiligo, and hyperhidrosis. For each condition, it discusses symptoms, types, potential causes, and treatment options including medications, phototherapy, and physiotherapy techniques. Physiotherapy can include ultraviolet radiation therapy, exercises to improve joint mobility and circulation, maintaining skin integrity and hygiene, and reducing friction. Ultraviolet radiation is used to treat several dermatological conditions like psoriasis and increase vitamin D production.
This project was developed for a competitive intelligence company by mining data from the various information sources e.g. Company (News, Investor Section, SEC filings, Annual Reports, Presentations etc), Universities/Medical Schools/Organizations, Medical Affairs Companies, Non- Profit Medical Agency, Government Agencies, Drug Delivery Companies, Contract Manufacturing Organizations, Contract Research Organizations, Consultancies and Financial Institutions. The complete information available there complied into a single MS word document, listed in MS Excel and then by using MS publisher it was converted into the report which finally converted into PDF.
The document provides an overview of multiple sclerosis (MS), including its history, types, signs and symptoms, diagnosis, and treatments. MS is an inflammatory disease that damages myelin in the central nervous system. It most commonly affects people aged 20-40 and is more prevalent in women. There are four main types of MS based on symptoms and progression. Diagnosis involves neurological exams, MRI scans, and spinal fluid tests. While there is no cure, current treatments aim to reduce relapses and slow progression by managing symptoms and suppressing the immune system.
Pediatric multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system that can affect children and adolescents under 18 years of age. While symptoms are similar to adult MS and include sensory deficits, optic neuritis, motor deficits and fatigue, diagnosis can be more challenging in children due to atypical presentations. The incidence is highest between 13-16 years of age and females are more commonly affected than males. Diagnosis involves evaluating clinical symptoms, MRI images showing lesions, and CSF analysis. Treatment involves disease-modifying drugs like interferons or corticosteroids for relapses.
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system where the body's immune system attacks the protective myelin sheath surrounding the nerves. It most commonly affects people between 20-40 years of age. While the exact cause is unknown, genetic and environmental factors are thought to play a role. The four main types are relapsing-remitting MS, primary-progressive MS, progressive-relapsing MS, and secondary-progressive MS. Symptoms vary depending on the affected areas of the brain and spinal cord but may include vision issues, weakness, numbness, and problems with coordination and balance. Diagnosis involves neurological exams, MRI scans and analysis of cerebrospinal fluid
1. Multiple sclerosis is a disease of the central nervous system where the protective myelin sheath around the axons is damaged, leading to scarring and demyelination.
2. It commonly affects people between the ages of 20-40 and has a higher prevalence in northern European populations and temperate climates.
3. Symptoms vary widely and can include changes in sensation, vision problems, weakness, and balance issues. Diagnosis involves MRI imaging and ruling out other potential causes through blood and spinal fluid tests.
Multiple sclerosis is a disease where the immune system attacks the myelin sheath surrounding nerves. This damages communication between the brain and body and can eventually damage nerves themselves. Symptoms vary depending on location of damage and affected nerves, and include numbness, vision problems, tingling, fatigue, and more. Most people experience relapses followed by remissions. Eventually, about 60-70% develop steady progression of symptoms. The cause is unknown but is believed to be autoimmune, and risk factors include age, sex, family history, and certain infections. Diagnosis involves ruling out other conditions and may include MRI, spinal tap, and blood tests showing abnormalities associated with MS. Treatment focuses on reducing inflammation with steroids or plasma
This presentation provides an overview of demyelinating diseases, focusing on multiple sclerosis (MS). It defines demyelinating diseases as those that cause myelin destruction while sparing other nervous system elements. MS is described as an autoimmune, inflammatory demyelinating disease of the central nervous system (CNS) that is more common in women. The presentation covers the pathology, clinical features, investigations, and treatment approaches for MS.
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that results in inflammation and damage to myelin. It affects more than 2 million people worldwide. Common symptoms include visual impairment, sensory issues, motor difficulties, and fatigue. While the exact cause is unknown, genetic and environmental factors are believed to play a role. There is no cure for MS, but treatments can help reduce relapses and manage symptoms. Exercise and rehabilitation are also important for improving physical function and quality of life for those living with MS.
This document provides an overview of demyelinating diseases of the central nervous system, with a focus on multiple sclerosis. It discusses the etiology, pathogenesis, clinical features, diagnosis, treatment and management of multiple sclerosis. Key points include: MS results from an autoimmune attack on the myelin sheath surrounding nerves in the brain and spinal cord; diagnosis involves evidence of lesions disseminated in space and time via MRI or other tests; and treatments include steroids for acute attacks and disease-modifying drugs such as interferons to reduce relapse rates long-term.
Multiple sclerosis (MS) is a chronic disease that damages the protective sheath surrounding nerve fibers in the brain and spinal cord. The immune system mistakenly attacks this sheath. Symptoms vary but can include vision problems, muscle weakness, and impaired coordination. The cause is unknown but likely involves genetic and environmental factors. Diagnosis involves ruling out other conditions and looking for lesions in the brain and spinal cord by MRI or lumbar puncture. There is no cure for MS but treatments can help manage symptoms and reduce relapses. Lifestyle changes and medications aim to reduce inflammation and manage symptoms like pain, fatigue, and bladder problems. Prognosis depends on the type and severity of early symptoms.
Multiple sclerosis is a chronic disease that damages the protective sheath surrounding nerve fibers in the brain and spinal cord. The immune system attacks this sheath, called myelin, which causes communication problems between the brain and body. The cause is unknown but likely involves genetic and environmental factors. Symptoms vary depending on the location of damage but can include numbness, vision problems, weakness, and impaired coordination. Diagnosis involves neurological exams, MRI images showing lesions in the brain and spine, and analysis of cerebrospinal fluid. While there is no cure, treatments aim to reduce frequency and severity of attacks and manage symptoms. Prognosis depends on the specific symptoms and disease progression in early years.
Multiple sclerosis is a chronic disease of the central nervous system characterized by multiple areas of inflammation and demyelination in the brain, spinal cord, and optic nerves. It commonly begins in young adults and is the most common chronic neurological condition affecting young people. Lesions appear separated in space and time throughout the central nervous system. Common symptoms include visual disturbances, limb weakness, and sensory changes. The cause is thought to involve an environmental trigger in a genetically susceptible individual, leading to an immune-mediated process. While there is no cure, treatment focuses on managing relapses, modifying the disease course, and controlling symptoms.
This document provides an overview of multiple sclerosis (MS). It begins by defining MS as a disease of the central nervous system involving destruction of myelin. It then discusses who is most likely to get MS, noting it occurs most often in Caucasians between ages 20-50 and more frequently in women than men. The document explains that in MS the immune system mistakenly attacks myelin. It describes the different types of MS and common symptoms. Diagnosis involves MRI, neurological tests, and spinal fluid examination. Treatment aims to reduce inflammation and immune system activity. The role of the immune system and proteins like GM-CSF and perforin in the development and progression of MS lesions is also summarized.
This document provides an overview of multiple sclerosis (MS), including its causes, pathophysiology, clinical features, diagnosis, course, classifications, and the role of MR imaging. MS is a demyelinating disease of the central nervous system that typically affects people aged 20-40. It has an unknown cause but is thought to involve genetic, viral, autoimmune, and environmental factors. Clinically, it presents with sensory issues, optic neuritis, spasticity, and other symptoms. Diagnosis involves identifying neurological abnormalities via history, exam, and MRI findings. The disease course is highly variable but can be classified as relapsing-remitting, secondary-progressive, primary-progressive, or progressive-
This document provides an overview of multiple sclerosis (MS), including its causes, pathophysiology, clinical features, diagnosis, course, classifications, and the role of MR imaging. MS is a demyelinating disease of the central nervous system that typically affects people aged 20-40. It has an unknown cause but is thought to involve genetic, viral, autoimmune, and environmental factors. Clinically, it presents with sensory issues, optic neuritis, spasticity, and other symptoms. Diagnosis involves identifying neurological abnormalities via history, exam, and MRI findings. The disease course is highly variable but can be classified as relapsing-remitting, secondary-progressive, primary-progressive, or progressive-
In his Master of Science in Osteopathy (M.Sc.O) thesis for London College of Osteopathy and Health Sciences (LCO), Dr. Arun Vijayan explores the potential benefits of osteopathic treatment techniques on symptoms related to Multiple Sclerosis.
Multiple Sclerosis And The Central Nervous SystemAmanda Brady
Multiple sclerosis is an autoimmune disease that affects the central nervous system, including the brain and spinal cord. It causes damage to the myelin sheath that surrounds nerve fibers, which can impair nerve signals. There is currently no cure for MS, but treatments can help suppress symptoms and slow progression. The disease is characterized by different types defined by periods of relapse and remission. Neurons transmit signals throughout the body, and damage from MS can disrupt these signals and cause issues like fatigue, vision problems, and mobility issues.
Multiple sclerosis and newer concept in management till 2014 maydrnikhilver
This document provides information about Multiple Sclerosis (MS), including what it is, possible causes, types, diagnosis, treatment and newer concepts in management. It defines MS as a chronic neurological disorder affecting the central nervous system, where myelin is destroyed in the brain and spinal cord. The exact cause is unknown but is believed to involve immunological, viral, environmental and genetic factors. Diagnosis involves clinical symptoms and tests like MRI, CSF examination and evoked potentials. Treatment includes managing acute attacks, reducing disease activity through medications, and symptom management. Newer oral medications and concepts in disease-modifying therapies are discussed.
This document provides information on Multiple Sclerosis (MS), including its epidemiology, etiology, clinical presentation, diagnostic tests, disease course, and treatment options. MS is an immune-mediated disease that attacks the central nervous system, destroying myelin and axons. Common symptoms include visual changes, numbness, weakness, and balance issues. Diagnosis involves MRI, lumbar puncture for cerebrospinal fluid analysis, and evoked potentials testing. The disease course varies between relapsing-remitting, primary progressive, and secondary progressive forms. Treatment focuses on reducing inflammation and disability through medications like interferon beta, glatiramer acetate, and natalizumab, as well as managing symptoms with drugs for pain,
Patients with spinal cord injury face a number of challenges, with continence being a top priority. For those affected by neurogenic bladder and bowel, there are various management options available. To help understand these options, study notes in this area can be useful. These notes, which are similar to index cards, can highlight key information related to the management of neurogenic bladder and bowel in spinal cord injury patients.
This document contains summaries of 4 research studies:
1. A randomized controlled trial that found suprascapular nerve blocks were no more effective than saline injections for treating subacute adhesive capsulitis.
2. A study that found intra-articular injections of hyaluronic acid plus dextrose for knee osteoarthritis resulted in greater improvements in physical function and pain reduction compared to hyaluronic acid plus saline.
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This document summarizes 4 research articles on topics related to physical medicine and rehabilitation (PMR). The first article finds that certain hematological parameters can predict abnormal CT scan findings and injury severity in pediatric patients with traumatic brain injury. The second article identifies sociodemographic and clinical factors associated with readmission within 30 days of hospitalization for traumatic brain injury. The third article estimates the minimal clinically important difference in Berg Balance Scale scores for patients with early subacute stroke who require walking assistance versus those who do not. The fourth article finds that early, intensive lower extremity rehabilitation shows preliminary efficacy in improving gross motor function in young children with perinatal stroke.
presentation about relation between posture and pain. there is lot of talk and research regarding bad posture and chronic pain. but posture, disease along with physical activity intervention should be done to manage.
community inclusion of people with disabilities mrinal joshi
Community inclusion aims to provide equal access and opportunities for people with disabilities through participation in employment, housing, education, recreation, and civic roles. Factors influencing participation include medical care, self-efficacy, physical abilities, accessible equipment and environments, social support, and disability policies. Promoting inclusion requires addressing barriers like low education, poverty, prejudice, and inaccessible settings through rehabilitation, community support, empowerment, and addressing social justice. Life care planning can support community reintegration by outlining medical, housing, equipment, preventative, and cost needs over a person's lifetime.
This document summarizes a systematic review that compared the effectiveness of task-specific training using assistive devices to task-specific usual care for improving upper limb performance after stroke. Seventeen studies were included in the review. A meta-analysis found that in the subacute phase post-stroke, task-specific training using assistive devices was more effective at reducing upper limb impairment than task-specific usual care alone, based on Fugl-Meyer Assessment scores. However, in the chronic phase post-stroke, both interventions led to similar improvements in upper limb performance, with no significant differences found between the groups. The review concluded that both interventions can improve upper limb function after stroke but task-specific training using assistive devices may
This study compared the incidence of neurobehavioral side effects of levetiracetam versus phenytoin in patients with traumatic brain injury (TBI). In a prospective observational study of 100 TBI patients treated with either levetiracetam or phenytoin, researchers found:
1. Levetiracetam was associated with significantly fewer neurobehavioral side effects than phenytoin, including less irritability, aggression, and confusion.
2. Phenytoin treatment resulted in nearly double the incidence of neurobehavioral side effects compared to levetiracetam.
3. Levetiracetam appears to be a better-tolerated antiepileptic drug for
This document discusses chemo-neurolysis, a technique using chemical agents to block nerves for managing spasticity. It provides a brief history of phenol use in neurolysis since the 1860s. While chemo-neurolysis was commonly used before botulinum toxin, its use has declined due to high botulinum toxin costs and lack of training. The document outlines various nerve blocks and injection techniques used to manage spasticity in specific muscles, such as the pectoralis nerve block. It discusses factors like phenol concentration and dosage. Potential side effects are also noted. The document advocates for chemo-neurolysis as a low-cost alternative for focal spasticity management.
The article discusses the impacts of the COVID-19 pandemic on physiatry and rehabilitation medicine. It highlights how physiatrists played a vital role in the front lines during the pandemic by converting rehabilitation units and innovating care delivery. However, the pandemic has also caused significant disruptions and stress for medical practices through reduced patient volumes, higher costs, and threats of reimbursement cuts from insurers and governments. Moving forward, physicians are questioning the level of support they will receive from their employers and the government given the sacrifices many have made during the pandemic.
This document discusses rehabilitation for spastic paresis. It begins by defining spastic paresis and related conditions like spasticity, dystonia, and contractures. It then describes the underlying upper motor neuron lesion pathology. The document outlines rehabilitation goals and assessments. It provides an overview of common physical rehabilitation protocols including stretching, splinting, constraint-induced movement therapy, gait training, strengthening, biofeedback, electrical stimulation, virtual reality, and robotic therapy. It discusses each technique and provides references to support the use of these approaches.
This document summarizes and discusses several articles on physical medicine and rehabilitation (PMR) topics that were published in recent issues of various journals. The articles cover a range of topics including the treatment of 12th rib syndrome, the use of the tourniquet ischemia test to diagnose complex regional pain syndrome, physiotherapy interventions for treating spasticity, a telehealth intervention to increase fitness for those with spinal cord injuries, spinal cord involvement in COVID-19, the use of local anesthetic injections in athletes, and a comparison of video-based and text-based physical activity interventions. The document also provides an introduction and welcome from the editor as well as information about new contributors.
Shoulder impingement occurs when soft tissues in the shoulder joint become entrapped and causes pain when raising the arm or lying on the affected shoulder. It is usually caused by overuse or repetitive strain without preceding trauma and affects those over 40 years old. Evaluation involves clinical exams, imaging like x-rays and MRI, and injections to diagnose impingement. Conservative treatments include immobilization, anti-inflammatories, physical therapy, cortisone injections, and exercises to strengthen muscles and improve range of motion.
1) The document summarizes several journal articles related to physical medicine and rehabilitation (PMR). It includes abstracts on topics like cognitive communication skills after mild traumatic brain injury, seizure comorbidity and hospital readmissions after traumatic brain injury, effects of traumatic brain injury and spinal cord injury on sexual function, the relationship between white matter hyperintensities and response to language treatment in post-stroke aphasia, using mental imagery therapy to treat neuropathic pain in spinal cord injury patients, and impairments in spatial navigation during walking in younger patients with mild stroke.
2) The editor's preface welcomes readers to the first issue of 2021 and thanks contributors and the recognition from IAPMR. It encourages readers to keep learning with the
The document presents the second edition of the "PMR Buzz" which provides abstract summaries from current rehabilitation medicine journals, and includes contributions from several rehabilitation experts. It contains a systematic review and meta-analysis comparing the effectiveness of autologous blood products and steroid injections for plantar fasciitis, and a randomized controlled trial comparing the effects of balance training and aerobic training for patients with degenerative cerebellar disease. The document aims to disseminate practice-changing research and receive feedback to improve the quality of information presented in future editions.
Cancer Rehabilitation. integrating rehabilitation with oncology. a model of care. cancer survivorship. rehabilitation care in low resource area. Mrinal Joshi. Rehabilitation Research Center. Jaipur.
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The document discusses different types of prosthetics including transfemoral sockets, ischial containment sockets, suction sockets, prosthetic knees, stance control knees, hydraulic knees, and pneumatic knees. It provides details on the design, advantages, and disadvantages of each type. The Dr. P.K. Sethi Rehabilitation Centre in Jaipur, India was the first private hospital in the country to have a prosthetics and orthotics center, established in 1985.
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In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
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Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
1. D R R A V I K H A T R I
3 R D Y E A R R E S I D E N T
M D P M & R
S M S M E D I C A L C O L L E G E A N D H O S P I T A L
J A I P U R
Rehabilitation Principles in
Multiple Sclerosis
PMR PG Teaching Sept 2016
2. DEFINITION
MS is a chronic progressive disease of the central nervous
system.
Brain and spinal cord are characterized by multiple areas of
white matter demyelination (inflammation).
These inflammatory sites lead to plaque formation that may
recur and enlarge with subsequent exacerbations and remissions.
3. Epidemiology
MS is the third leading cause of significant disability in the 20–
50 age range
The exact cause is unknown
It affects F>M 2:1, Whites>>>>Blacks, Asians (Middle-aged
adults)
There is an increased incidence in the higher socioeconomic class
(+) Family history involving siblings > parents (4–5%)
4. Cont…
Although females have a higher risk of having MS, those males
who are affected tend to have a more aggressive course, difficulty
with recovery after attack, and more rapid accumulation of
disability.
5. Pathogenesis
Genetic Linkage
MS is thought to be an autoimmune disease in which
immune and inflammatory cells attack the CNS, damaging the
myelin, axons, and neurons.
Genetic Risk of Multiple Sclerosis
6. Cont…
Environmental Factors
The incidence of MS increased with distance from the equator.
The effects of vitamin D have demonstrated that reduced levels
of vitamin D increases the risk of MS development, particularly
in whites.
Twenty minutes of whole-body sun exposure equates to
approximately 10,000 International Units of vitamin D.
More research supports changing the minimum daily
consumption of vitamin D because it is found to be protective in
several other diseases.
7. Cont…
Other Factors
A BMI of >20 increases the risk of MS and a BMI ≥27 increased
the risk by twofold. Obese females between 10 and 20 years old
seem to be at greater risk than males during the same time
period.
Increased clinical and radiologic activity with increased sodium
intake has been suggested as another cause of MS.
8. Cont…
Immunology
The pathologic hallmarks of acute MS lesions are perivenular
immune cell infiltrate, demyelination, myelin laden
macrophages, edema, and axonal damage.
Relapses in MS are thought to be mediated by CNS-targeting
peripherally activated helper lymphocytes.
These autoreactive lymphocytes could have been activated
through “molecular mimicry,” in which foreign antigens (e.g.,
viral or bacterial proteins) that are similar to CNS antigens
activate the lymphocytes that will eventually react against the
self-antigens.
9. Cont…
On the other hand, antigens leaked from the CNS, probably
resulting from a previous unknown insult, can trigger the
immune response by activating CD4+ helper T cells. These cells
facilitate the recruitment and activation of other immune cells—
for example, monocytes and macrophages, B cells, CD8+
cytotoxic T cells, and natural killer cells.
It is not clear which autoantigen(s) ignite the autoimmune
process in MS.
10.
11. Subtypes
Relapsing-remitting MS (RR-MS)
More than 80% of the cases
Defined clinical exacerbation of neurological symptoms
Followed by complete or incomplete remission during which the
person fully or partially recovers from the deficits acquired
during relapse
12. Cont…
Primary-progressive MS (PP-MS)
10 to 20% of individuals with MS are diagnosed with PP-MS
Gradual progression of the disease from its onset
No overlapping relapses and remissions
13. Cont…
Progressive-relapsing MS (PR-MS)
Rare
Initially presenting as PP-MS however, during the course of the
disease the individuals develop true neurologic exacerbations
Steady progression of clinical neurological damage with
superimposed relapses and remissions.
14. Cont…
Secondary Progressive MS (SP-MS)
SP-MS is characterized by a steady progression of neurological
damage with or without superimposed relapses and minor
remissions
Individuals with SP-MS will have experienced a period of RR-
MS, which may have lasted from 2 to 40 years
Any super-imposed relapses and remissions fade over time
18. Common signs
Lhermitte’s sign: Classic but not pathognomonic.
Passive neck flexion causing an electric shock-like sensation
radiating to the spine, shoulders as well as other areas. This sign
is most likely a result of the increased sensitivity of the myelin to
stretch or traction
Uhthoff's phenomenon is the worsening of neurologic
symptoms in multiple sclerosis and other neurological,
demyelinating conditions when the body gets overheated from
hot weather, exercise, fever, or saunas and hot tubs.
19. Diagnosis
Because of the similarity MS has to various other neurologic,
rheumatologic, and vascular diseases, MS remains a diagnosis of
exclusion.
It is important to distinguish and exclude other demyelinating
disorders, including neuromyelitis optica (NMO), acute
transverse myelitis, and acute disseminated encephalomyelitis
(ADEM).
20. Cont…
Criteria for diagnosis of NMO include both optic neuritis and
acute myelitis, plus two of the following three factors: contiguous
spinal cord involvement spanning three spinal segments or
more, exclusion of MS, and NMO–immunoglobulin G (IgG)
seropositive status.
Acute transverse myelitis presents acutely, may be monophasic
or multiphasic, and has a clearly defined sensory level with
exclusion of other causes. It is a focal inflammatory disorder of
the spinal cord and may result in abnormalities in motor,
sensory, or autonomic function.
21. Cont…
MRI is recommended for the diagnostic evaluation in MS.
The International Panel on Diagnosis of MS (the Panel)
recommends screening with MR sequencing.
The McDonald criteria are the most current and widely used to
diagnose MS.
22. Cont…
Dissemination in space is met by having one or more T2 lesions
in two out of four locations in the CNS:
periventricular
juxtacortical
infratentorial, and
spinal cord
Dissemination in time was met by the presence of a new T2
and/or gadolinium-enhancing lesion on a follow-up MRI,
irrespective of the timing or the simultaneous presence of
asymptomatic gadolinium-enhancing lesions and nonenhancing
lesions
24. EDSS is a method of quantifying disability
in multiple sclerosis based on eight Functional
Systems (FS)
Expanded Disability Status Scale (EDSS)
•Pyramidal (ability to walk)
•Cerebellar (coordination)
•Brain stem (speech and swallowing)
•Sensory (touch and pain)
•Bowel and bladder functions
•Visual
•Mental
•Other (any other neurological findings)
Normal
Neurological Exam
0.0
Death due to MS10.0
1.0
4.5
5.0
9.5
Fully ambulatory
Ambulation
impairment
A graph showing the average time a person spends in each EDSS level.
27. Physical Activity
A person with a disability is prone to inactivity and
deconditioning.
Current recommendations for physical activity are meant for
individuals without physical disability and those guidelines are
often not applicable to the population with disabilities.
Exercise is helpful for PwMS with no evidence for deleterious
effect. The intensity, duration, and frequency must be coupled
with a patient’s symptoms, heat intolerance, strength, and
endurance.
29. Gait Impairment
Mobility impairment is one of the most common single
disabilities in PwMS.
Approximately 75% of PwMS have mobility challenges.
There is an increased risk of weakness, spasticity, contractures,
bone mineral changes, cardiovascular changes, reduced
independence, and reduced quality of life. Overall, long-term
positive prognostic indicators for disability and gait impairment
include female gender, young age, complete recovery of initial
exacerbation (specific to the RRMS subtype), and reduced
relapse rate in the first 5 years.
30. Cont…
The Timed 25 (T25) Foot Walk Test is a validated measure of
walking speed in MS. A 20% change in walking speed is
considered significant and clinically meaningful.
Other gait tests, such as the Two- and Six- Minute Walking Tests
have demonstrated correlation to ambulation and physical
fatigue in PwMS.
Dalfampridine was approved for the use of PwMS with walking
impairment in 2010 based on the results of two phase III
randomized, placebo-controlled trials. Approximately one third
of participants displayed 25% improvement in their Timed 25
walking speed.
31. Cont…
Dalfampridine is given at a dose of 10 mg every 12 hours.
A history of seizures is an absolute contraindication because
dalfampridine lowers the seizure threshold.
Other adverse events include increased frequency of urinary tract
infections, vertigo, insomnia, headache, and falls.
Dalfampridine is renally excreted; therefore, a baseline basic
metabolic panel is advised because adequate creatinine clearance
(51 to 80 mL/min) is vital.
32. Fatigue
Fatigue remains one of the most common and debilitating
symptoms in MS and is quoted as one of the single most
disabling symptoms.
Patients commonly describe fatigue as a “reversible motor and
cognitive impairment, with reduced motivation and desire to
rest.”
Individuals with MS may experience two types of fatigue:
peripheral and central. Peripheral fatigue is associated with
fatigability, that is, a generalized sense of exhaustion affecting
the patient after a few minutes of physical activity and is
alleviated with rest.
33. Cont…
Central fatigue is subjective and is associated with dysfunction in
arousal and attention. The individual reports a feeling of
constant exhaustion or lassitude that can lead to worsening
vision or function. Rest will not have an effect on central fatigue
and thereby has a significant impact on function, quality of life,
relationships, and even maintenance of occupation/vocation.
34. Cont…
Awareness of triggering factors such as heat, stress, or
overexertion should be emphasized. Also, energy conservation
techniques and training are advised.
In addition to energy conservation and avoidance of triggers,
pharmacologic treatment is advised to help maintain energy and
focus.
36. Sleep Disorders
Approximately 10% of the general population suffers from
insomnia, whereas approximately 40% to 50% of PwMS report
difficulty with sleep initiation, maintenance, or have early
morning awakening.
Symptoms of MS that may interfere with sleep include spasticity,
pain/paresthesias, and nocturia.
Treatment agents include zolpidem, trazodone, benzodiazepine,
sedating antidepressants, and antihistamines.
37. Cont…
Sleep-disordered breathing, obstructive sleep apnea, and central
sleep apnea may be the etiology of persistent fatigue in PwMS.
Obstructive sleep apnea is a result of upper airway obstruction
during sleep.
Central sleep apnea is the lack of respiratory effort during sleep.
Patients with clinical or radiologic evidence of brainstem
involvement had elevated Apnea-Hypopnea Index (episodes of
obstructive apneas, central apneas, or hypopneas per hour of
sleep) than those without brainstem involvement.
38. Cont…
Besides obstructive sleep apnea and central sleep apnea, other
sleep-related movement disorders include restless leg syndrome
(RLS) and periodic limb movement disorder (PLMD).
Patients with RLS should undergo screening for iron deficiency
because this may contribute to symptoms. Treatment for both
RLS and PLMD includes dopaminergic agents, benzodiazepine
(clonazepam), and anticonvulsants.
39. Mood Disorders
The most common mood disorder in MS is depression. It is present in
at least 50% of patients.
The lifetime prevalence of depression in MS is three times that of the
general population.
The overlap of symptoms in both depression and MS (fatigue, poor
concentration, sleepiness/ fatigue, and appetite disturbance) can lead
to underdiagnosis of depression and has delayed the diagnosis of MS.
Screening for DMT-related side effects, particularly IFNs, is advised.
Some patients may have mood disorders secondary to DMT and may
benefit from a change.
40. Thermoregulation
The pathophysiology of MS is one of central demyelination.
Physiatrists are keenly aware of the effects of segmental demyelination:
reduction in conduction velocity, altered saltatory conduction, and
eventual conduction block.
The safety factor (ratio of action current available at a node to
threshold current) is responsible for successful conduction. Advanced
demyelination reduces the safety factor.
Heat causes alteration of the sodium channels and also reduces the
safety factor and amplitude of nerve action potentials. A demyelinated
nerve is more vulnerable to heat-related changes than the unaffected
nerve.
41. Cont…
Heat intolerance is a well-established symptom in PwMS.
Uhthoff phenomenon, a transient loss of vision or blurred vision,
after a hot bath or exercise is common.
Heat causes transient worsening of many symptoms of MS and
can cause fatigue.
The “Hot Bath Test” was used before the availability of MRI to
diagnose patients with MS.
42. Cont…
Exposure to heat can cause worsening of both physical and
cognitive function. Autonomic dysfunction also contributes to
poor temperature regulation in PwMS.
Patients should be counseled about prevention and treatment
options to prevent potentially fatal injuries from occurring.
Avoidance of warm baths or swimming in heated pools is
advised. In general, water temperatures no greater than 84° F
(26.7 to 28.9° C) is advised.
43. Spasticity
Spasticity affects up to 85% of PwMS. Lower limb spasticity is
much more common (97%) than upper limb spasticity (50%).
Oral baclofen is the usual first-line oral agent. Tizanidine may be
limited given its sedating side effects. Clonazepam is helpful in
cases of PLMD or nighttime spasms.
The benefit of chemodenervation with botulinum toxin (BoNT)
injections in MS is paramount, resulting from the difficulty with
tolerance of oral antispasmodics.
44. Cont…
Intrathecal baclofen (ITB) therapy via an implanted drug delivery
device is indicated when oral or injectable treatment becomes
ineffective. The clinician is encouraged to use this therapy before the
onset of significant walking impairment or lower limb weakness.
The use of ITB pumps in patients with MS has demonstrated
improvements in spasticity, quality of life, sleep quality, bowel and
bladder performance, skin integrity, and ambulation with low
complication rates.
Phenol injections or surgical intervention may be used in patients with
severe mobility or contractures and have failed conservative therapies.
45. Pain
Patients with MS experience neuropathic and nociceptive pain.
Prevalence studies report that 29% to 86% of patients are
affected by pain.
Neuropathic pain arising as a direct consequence of a lesion or
disease that affects the somatosensory system.
Nociceptive pain is attributable to stimulation of nociceptors that
signal tissue irritation or injury to elicit an appropriate response.
Pain negatively impacts mood, energy, daily activities, vocation,
social interaction, and has been linked with reduced quality of
life in PwMS.
46. Cont…
Neuropathic pain has a prevalence of 50% in MS and is believed
to be a result of the presence of plaques in the CNS (particularly
the corticospinal and dorsal column tracts), causing symptoms of
allodynia and hyperalgesia.
Patients respond well to anticonvulsant treatment, particularly
gabapentin.
Another agent in the same class is pregabalin. Although effective
for its treatment effect, its side effect profile is difficult for some
patients (edema, sedation, weight gain, constipation).
47. Cont…
Other agents in the anticonvulsant class include levetiracetam,
lamotrigine, and zonisamide.
The tricyclic antidepressant class may also be used to treat
neuropathic pain; again, the side effect profile (dry mouth,
constipation, drowsiness, urinary retention) may pose a
challenge for patients.
Patients who are unable to tolerate the side effects or obtain
clinically meaningful relief from oral medications may consider
intrathecal therapy.
48. Cont…
Morphine and ziconotide are both approved for management of
neuropathic pain via intrathecal infusion.
Ziconotide is a nonopioid agent and demonstrated significant
pain reduction over placebo.It selectively targets voltage-gated
calcium channels and prevents primary afferent transmission of
pain signals in the spinal cord.
Common side effects of Ziconotide include dizziness, nausea, and
confusion. It is a viable option for patients that are not opioid
responsive and does not cause tolerance, dependence, or
respiratory depression.
49. Cont…
Trigeminal neuralgia (TN) affects approximately 2% to 6% of
patients with MS and is 20 times more common in PwMS.
It may be a result of focal compression of the trigeminal nerve
root near its entry at the pons (primary TN) or as a result of a
neurologic diagnosis such as demyelinating plaques in the same
region or a posterior fossa tumor (symptomatic TN).
Patients complain of spontaneous, unilateral, lancinating
“electrical sparks.” Light, tactile sensation or pressure may
stimulate the pain.
The pain can last for seconds to hours.
50. Cont…
Treatment options include anticonvulsants (carbamazepine,
gabapentin, lamotrigine, topiramate), antispasmodics (baclofen),
and in rare instances, narcotics.
Again, most PwMS are hesitant to take opiates because of the
cognitive and physical clouding that may occur.
Finally, misoprostol, a prostaglandin E analogue relieved pain in
patients with TN and should be considered.
Misoprostol is believed to be effective because the T cell
inhibition caused by prostaglandins leads to an antiinflammatory
effect in plaques.
51. Cont…
Doses of misoprostol ranged from 100 to 200 mg titrated up to
four times a day.
Patients refractory to or unable to tolerate oral medications may
consider BoNT injections or neurosurgery referral for
microvascular decompression, rhizotomy, or gamma knife
repair.
“MS hug” is described by patients as a feeling of tightness across
their ribs, as if they were being hugged very tightly.
52. Cont…
The cause of “MS hug” is unknown.
Burning and tingling sensations are common.
Treatment with anticonvulsants or topical compound mixtures of
anticonvulsants and lidocaine are suggested.
54. Neurogenic Bladder
The presence of lesions in the brain and/or spinal cord may lead
to disorders of emptying (double voiding, incomplete emptying,
slow or intermittent stream), storage (urinary urgency,
frequency, nocturia, incontinence), or a mixture of both
(detrusor sphincter dyssynergia).
It affects up to 75% of PwMS.
Treatment includes pelvic muscle training, medication, BoNT
injection, and surgery.
55. Cont…
Pharmacologic treatment consists of antimuscarinic agents for
treating disorders of storage.
α-Antagonists are commonly recommended for treatment of
voiding disorders.
Desmopressin may be indicated for symptoms of nocturia.
BoNT type A (BoNT-A), specifically Onabotulinum Toxin, is
FDA-approved for the treatment of neurogenic detrusor
overactivity in PwMS. Intravesical injections of BoNT-A have
been found to increase the bladder capacitance and reduce
episodes of urinary incontinence.
56. Cont…
The benefits have been reported to last up to 8 to 10 months,
although injections may be performed every 6 months.
Patients should be advised of a possible need to catheterize post
injection if post void residuals are elevated.
Nerve stimulation has also been evaluated for treating
neurogenic bladder disorders.
57. Cont…
Posterior tibial nerve stimulation involves needle insertion
superior and medial to the medial malleolus with stimulation
sufficient to induce toe flexion and tingling distal to and
including the ankle.
The procedure is indicated in patients who failed or are unable to
tolerate conservative treatment for overactive bladder and
typically involves 12 × 30-minute weekly sessions.
The use of posterior tibial nerve stimulation demonstrated a
clear reduction in urinary incontinence, urgency, frequency, and
number of incontinence pads used.
58. Cont…
Sacral nerve stimulation is another option for the treatment of
hyperreflexia, urge incontinence, and urgency/ frequency
disorders.
The exact mechanism of action is unknown, but it is believed to
restore the balance between excitatory and inhibitory
stimulation of the sacral and suprasacral regions.
A trial period is advised for 3 to 7 days with pretrial and posttrial
voiding diary evaluation for effectiveness.
This is a surgical procedure and its use in MS is limited because
of limited MRI compatibility of the devices.
59. Neurogenic Bowel
Neurogenic bowel presents as constipation or fecal incontinence.
Constipation is believed to be caused by immobilization or
abnormal colonic contractility, tone, or recto-anal reflexes.
Fecal incontinence may be attributable to loss of control of the
external anal sphincter, abnormal recto-sigmoid compliance, or
recto-anal reflexes.
The use of probiotics can help both constipation and
incontinence.
60. Sexual Dysfunction
Sexual dysfunction (SD) is present in approximately 42% to 90%
of PwMS.
Women commonly report decreased libido and loss of
lubrication. Men report erectile and ejaculatory dysfunction.
Both sexes report challenges with achieving orgasm.
Primary SD may be caused by CNS demyelination that directly
impairs sexual feelings and/or the response. This includes
symptoms of decreased or loss of libido, paresthesias that make
the sexual encounter painful or unpleasurable.
61. Cont…
Secondary SD is attributable to disability secondary to MS, and
are items that indirectly affect the sexual response. This may
include neurogenic bladder or bowel symptoms, spasticity,
tremor, or immobility.
Tertiary SD involves one’s view of self and the psychological
impact that culture and society place on sex and intimacy. Family
dynamics, interpersonal conflict, poor self-esteem, and altered
views of one’s body image are included.
62. Cont…
Management includes education and communication.
Reducing the dependence on medications for side effects that
impair libido or energy as well as using medications that reduce
spasms or pain may be needed.
Sildenafil citrate is effective for male patients with erectile
dysfunction.
Women with SD were trialed on sildenafil citrate for
improvement in sexual response, blood flow, and improved
neurophysiologic response.
63. Cognitive Impairment
Cognitive impairment (CI) may be present at any stage of MS.
Approximately 40% to 70% of patients have CI.
Impairments that are commonly seen in PwMS include episodic
memory loss, attention deficits, delayed processing speed, and
difficulty in executive function. Dementia is less commonly
present in MS.
Various structural factors on MRI have correlated with CIs in
PwMS. Increased cortical atrophy, widening of the third
ventricle, and overall loss of brain volume are seen in persons
with CI.
64. Cont…
Factors that may affect CI include disease duration, MS subtype,
level of disability, and pre-morbid level of verbal competence.
One striking feature is the concomitant presence of depression or
depressive symptoms in patients with CI.
Subcutaneous IFN-β1a and IFN-β1b can stabilize or delay the
progression of CI in persons with RRMS.
One year of natalizumab treatment actually demonstrated
significant improvement in cognitive performance and fatigue in
patients with RRMS.
65. Cont…
In addition to DMT, cognitive behavioral therapy has reduced
distress and improved cognitive performance in several small
studies.
66. Swallowing
Dysphagia, or difficulty with swallowing liquids or solids, may
present at any stage of MS.
An estimated 33% to 43% of patients are affected.
The prevalence of dysphagia increases with increasing disability.
The etiology of dysphagia in MS is likely to be attributable to the
involvement of cortico-bulbar, cerebellar, or brainstem regions.
Treating dysphagia with compensatory strategies is often
effective.
67. Cont…
This includes (1) postural changes, (2) modifying the amount of
food bolus consumed, and (3) changing the food consistency.
Other treatments include electrical stimulation and neurotoxin
injection.
Pharyngeal electrical stimulation to treat oropharyngeal
dysphagia significantly reduces the amount of penetration and
aspiration.
Injection of BoNT into the cricopharyngeal muscle has been
reported to be effective for the treatment of upper esophageal
hyperactivity.
68. Pseudobulbar Affect
Pseudobulbar affect (PBA) is a disorder of uncontrollable
laughter or crying that is incongruent with the social or
professional situation.
Although PBA can be seen in almost any illness, this is
commonly seen in persons with neurologic disorders including
MS, amyotrophic lateral sclerosis, stroke, and traumatic brain
injury.
Prevalence in MS is believed to be 6.5% to 46.26%.
69. Cont…
Patients who suffer from this may feel socially isolated resulting
from the lack of control over their laughing or crying episodes.
PBA should be differentiated from depression in which one’s
mood is congruent to the situation. Also, duration of symptoms
is brief in PBA, whereas a depressed mood typically lasts weeks
to months.
The pathophysiology is not clear but is believed to be a disorder
of the cortico-pontine-cerebellar circuit. It is thought that
disruption here can lower the threshold for emotional
response.This disruption is believed to lead to the emotional
incongruent response.
70. Cont…
Various agents including selective serotonin reuptake inhibitors
and tricyclic antidepressants have been used with varying
success to treat PBA.
The combination of dextromethorphan with low-dose quinidine
has resulted in a treatment for patients with PBA. Its mechanism
of action is unknown.
The recommended dosage is 1 capsule daily for 7 days followed
by 1 capsule every 12 hours beginning on day 8. Most patients
notice reduction in lability after 1 to 2 weeks of treatment.
71. References :
Braddom's Physical Medicine and Rehabilitation - 5E
Physical Medicine and Rehabilitation Board Review